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S146
Poster presentations / European Geriatric Medicine 6S1 (2015) S32
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S156
P-425
A study to increase the applicability and validity of the FORTA
(Fit fOR The Aged) List in Europe
M. Wehling
1
, F. Pazan
2
1
Medical Faculty Mannheim University Heidelberg, Mannheim,
Germany;
2
Heidelberg University, Institute of Experimental and
Clinical Pharmacology and Toxicology, Mannheim, Germany
The population of elderly people in Europe is constantly growing.
Nonetheless, the pharmacotherapy of the aged is still in many
cases inappropriate. Many studies have shown that a large fraction
of the elderly is subject to over- and/or undertreatment. The major
problem is that for most of the medications there is little to
no evidence for efficacy and safety in elderly patients. Moreover,
the presence of multimorbidity and consequently polypharmacy
escalates this issue. In order to adequately address this problem and
to increase the appropriateness and quality of pharmacotherapy of
older people, our group has developed a clinical aid called the
FORTA List. FORTA was originally proposed by Wehling and the
FORTA List was validated by experts from Germany and Austria in a
Delphi Consensus procedure. Besides this, we assessed FORTA’s
utility in a pilot clinical trial and in a randomized controlled
prospective study. These two studies demonstrated that FORTA
significantly improves the quality of medical therapy. In addition,
even some secondary endpoints of our studies were improved.
Therefore, we planned to conduct a consensus validation of a
country-specific FORTA list in 7 European countries/regions to
increase the applicability of FORTA. For this purpose, we selected
the leading experts in the field of geriatrics, geriatric psychiatry,
neurology and pharmacy with high experience in pharmacotherapy
to validate the FORTA List in a Delphi consensus procedure. Finally,
we are going to use the results of our study to develop a European
FORTA List which will serve to increase the applicability of FORTA.
P-426
Clinical validation of the FORTA (Fit fOR The Aged) List in
a prospective randomized controlled clinical study
M. Wehling
1
, A. Kuhn-Thiel
1
, C. Throm
1
, H. Burkhardt
2
,
H. Frohnhofen
3
, F. Pazan
4
, C. Weiss
5
1
Medical Faculty Mannheim University Heidelberg, Mannheim,
Germany;
2
Germany;
3
Essen-Mitte Hospital, Knappschafts Hospital,
Teaching Hospital, University of Duisburg-Essen, Essen, Germany;
4
Heidelberg University, Institute of Experimental and Clinical
Pharmacology and Toxicology, Mannheim, Germany;
5
Department
of Biometry and Statistics, Medical Faculty Mannheim, Heidelberg
University, Mannheim, Germany
The lack of evidence of the efficacy and safety of many drugs
has been a major issue in the pharmacotherapy of the elderly.
Hence physicians and other healthcare providers face difficulties in
choosing the appropriate medication for the aged on a daily basis.
The FORTA categorization (A: Absolutely; B: Beneficial; C: Careful;
D: Don’t) was proposed as a clinical aid for increasing the quality of
pharmacotherapy in the elderly. The FORTA list was developed in a
Delphi process and a pilot clinical study indicated its practicability.
To further assess the effectiveness of FORTA we conducted a
prospective randomized controlled trial in hospitalized patients
in a geriatric ward. Nearly half of our cohort, received standard
care and the other half received standard care plus the FORTA
method. We determined the changes in medication and over- and
under-prescription rates according to FORTA as well as alterations
of relevant clinical endpoints such as the Barthel Index (BI), number
of falls, pain scale and Tinetti Tool score between admission
and discharge. In a preliminary analysis, both over- and under-
treatment was reduced significantly in the intervention group
versus the standard care group. In addition, the number of A-
labeled drugs increased and the number of C- and D-labeled
drugs decreased significantly in the intervention group.However,
the number of drugs and thus polypharmacy remained unchanged.
Based on our results, FORTA has great potential for use as an aid to
optimize the pharmacotherapy of the aged.
Pre- and postoperative care
P-427
The use of fascia iliaca block infusions in patients presenting
with neck of femur fractures
Z. Akhtar
1
, C. Allen
2
, B. Langton
2
, H. Watters
2
, H. Barker
2
,
M. Raymond
2
, R. Lisk
3
1
NHS, Surrey, England;
2
St Peter’s Hospital, Surrey, England;
3
Ashford & St Peter’s NHS Trust, Chertsey, United Kingdom
Objectives:
A study found Fascia iliaca block infusion (FIBi) use in
patients with Neck Of Femur fractures (NOF) resulted in a reduction
in hospital length of stay (LOS) and pain score despite a reduction in
opioid usage[1]. In our hospital, single fascia compartment blocks
are administered for symptom control. We aim to deduce the effects
of FIBi on pain control, mobility and LOS in patients with NOF
fractures.
Method:
55 patients with a NOF fracture admitted between August
2014 and January 2015 were recruited. 21 patients were given
FIBi and 34 (control) had regular analgesia as per trust guidelines.
Baseline characteristics were compared between the 2 groups. Pain
and mobility score were compared post-operatively days 1, 2 & 3.
Results:
Baseline characteristics compared age in FIBi (80) and
controls (84); resident status (86% vs 94% from own home),
preadmission mobility (55% vs 47% mobile without aid) and ASA
grade (2.24 vs 2.21). FIBi use resulted in lower pain score (1.78 vs
1.86) and improved average mobility score (1.52 vs 1.25) (p = 0.66 &
p = 0.22 respectively). Acute LOS (11 vs 13.5 days) and overall Trust
LOS (15.7 vs 17.9 days) in the FIBi group was reduced. 81% patients
in the FIBi were discharged to usual residence within 30 days
compared to 67.6% of control
Conclusion:
FIBi use in NOF fracture patients resulted in better
post-operative pain control and improved mobility with a reduction
in the total LOS of 2.2 days with potential savings of £242,000 in a
year (Trust bed stay costs £275).
P-428
Geriatricians provide high quality, safe and valued service
on acute orthopaedic unit. POPS-SO, perioperative care of
older people undergoing surgery
–
Salford Orthogeriatrics
Z. Alio
1
, K. Wardle
1
, N. Pendleton
1
, E. Feilding
1
, M.K. Peeroo
1
,
J. Fox
1
, A. Vilches-Moraga
1
1
Salford Royal NHS Foundation Trust, Salford, Manchester, United
Kingdom
Objectives:
The role of geriatricians in management of older
patients with acute fractures is well recognised. The orthogeriatric
service at Salford Royal NHS Foundation Trust was expanded in
2013 to promote high quality care for older orthopaedic patients.
We aimed to assess the impact of our expanded service on staff.
Methods:
Our Service provides comprehensive geriatric assess-
ment, daily medical review and multidisciplinary boardrounds.
There are weekly multidisciplinary team meetings and Harm Free
Care evaluations (reviews of blood, radiology and microbiology
results with weekend handover).
An anonymous electronic survey aiming to assess the impact of the
service was sent out in May 2015.
Results:
We received 30 replies; 17 were from doctors, and 13 were
from nursing staff, AHPs and members of the service team. Most
respondents (29/30) had daily or frequent contact with the service.
All respondents felt that the service was very helpful and provided
high quality patient care as well as value in communication with